Background: Management of persistent pulmonary hypertension of the newborn (PPHN) in resource-limited settings requires effective utilization of available therapeutic options. While inhaled nitric oxide remains the gold standard, alternative pulmonary vasodilators offer viable treatment strategies where advanced therapies are unavailable. Objective: To evaluate the management strategies, pulmonary vasodilator therapy effectiveness, and clinical outcomes of neonates with PPHN in a resource-limited rural tertiary care center. Methods: This descriptive longitudinal study analyzed 80 neonates with echocardiographically confirmed PPHN treated at Dr. Balasaheb Vikhe Patil Rural Medical College from June 2022 to June 2024. Treatment protocols included oxygen supplementation, mechanical ventilation, and pulmonary vasodilators (sildenafil, milrinone, dobutamine). Outcomes were assessed based on hospital stay duration, treatment response, and mortality. Results: Parenteral sildenafil was the most utilized vasodilator (67.5%), followed by milrinone (50%) and dobutamine (32.5%). High-flow nasal cannula was used in 70% of patients, while 43.8% required mechanical ventilation. Severe PPHN cases showed higher utilization of milrinone (60%, p=0.0004) and mechanical ventilation (68.6%). Duration of oxygen therapy was <7 days in 66.3% of cases, with longer duration significantly associated with severe PPHN (p=0.013). Overall survival rate was 78.9% with 21.3% mortality. Mechanical ventilation was significantly associated with mortality (48.57% death rate, p<0.001). Mean hospital stay was 11.46±5.84 days, with survivors having significantly longer stays than non-survivors (p=0.003). Sildenafil use showed significant improvement in outcomes (p=0.04). Conclusions: Pulmonary vasodilators, particularly sildenafil and milrinone, provide effective treatment options for PPHN in resource limited settings. Early initiation of appropriate vasodilator therapy, coupled with optimal respiratory support, significantly improves outcomes. The study demonstrates that good survival rates can be achieved without advanced therapies like inhaled nitric oxide or ECMO, making these protocols valuable for similar resource-constrained environments.